Second Opinion in India

Seeking second opinion for a medical problem means evaluating the patient for the same medical problem to give another opinion on the diagnosis or the proposed plan of care.

At times it is required in difficult situations wherein the patient is apprehensive of a surgery or a complex medical problem or when the treatment has been going on since long without showing effective results. Even at times a family physician, also known as a family doctor in India, seeks second opinion of a specialist in a complicated condition. Although there is no data to understand how many people are seeking second opinion as at times patient don’t reveal to their family physician about the second opinion he / she has sought which could be cause of various reasons including but not limited fear of losing trust of the family physician. At the same time they seek second opinion when they patients are not satisfied with the services being availed. Moreover some malpractices by doctors are also leading to increased use of second opinion particularly where costs are prohibitive and involve surgery. Even if treatment doesn’t involve surgery, Second opinion is also valuable in case of chronic diseases.

Need for second opinion will also grow when various insurance companies try to seek second opinion of doctors to understand whether the treatment done was actually required or not. There have been concerns raised in the past that doctors have resorted to expensive treatments when the same ailment could have been treated at a much lower cost. This assumes further significance when dealing with the lives of patients particularly in cases of coronary diseases where expensive stents are used.

Unfortunately in a country like India where there is lack of transparency in medicine and medicines and pathological tests (by few physicians) are prescribed keeping in mind self interests (Gifts and commission from Pharma companies and Pathlabs),Second opinion will become more prevalent with every passing day. Companies like RxOcean have taken the first step in that direction. All sorts of specialists (critical care specialists, pediatricians, orthopedicians, family physicians, diabetes specialists) are available under one umbrella called as RxOcean and they are just a click away from the patients.

Online portals like RxOcean let patients seek second opinion from home

n the month of September 2010, Bhagwan Devi Munjal faced a decision between two types of follow-up treatments for her broken shoulder bone: the standard, six to eight week-long normal therapy which lets the bone join on its own, or surgery to join the bone and get cured within 2 weeks. Although cost wasn’t a concern but her age was. Although the orthopedician consulted had assured that the age is not a concern and surgery would be a better option as the person would be able to recover fast in case of surgery but family physician had her own doubts about the case and she wanted to seek second opinion from other specialist orthopedicians to ensure that surgery would be beneficial.

But Bhagwan Devi, 85, decided not to travel to Delhi or any other place from her current native place. Instead her family discovered that by submitting her medical records through a service available on www.RxOcean.com, she could obtain a second opinion from a top specialist without leaving home.

“It would have been very cost-prohibitive and tiresome for me to travel to couple of hospitals in different cities. I accomplished the same thing without that expense,” she says.

Online second-opinion services offer patients consultations from specialists based on the medical records that they fax, mail or send via the Internet. The average cost, payable upfront via credit card or online transfer to the bank accounts of the organization cost anywhere between INR 150 to INR 500, depending on the number and type of specialists one wants to consult. Patients then receive online access to a second opinion in about a day or two again depending upon the case. In cause of an emergency, RxOcean claims to make these services available within couple of hours thus helping the patients when they need the help most.

Since www.RxOcean.com went online in early 2010, about 100 patients have already taken advantage of the service in last six months, says Dr Kirti Soota, co-founder of the web services company. Some of the patients were not satisfied with the treatment that they were undergoing, some just wanted to ensure that treatment is ok, some people who approached us didnt understand what their doctor wanted to tell them as a result they wanted to have a word with another doctor and a few wanted to discuss issues over the phone related to their sex problems and marital problems for which they didnt want to see a doctor face to face. Many a times these problems just need counseling patients and some OTC drugs are advised. In case we feel the case is serious or diagnosis is wrong then either request the patients to get some more tests done or consult another doctor face 2 face. As was the case with Mrs Bhagwan Devi wherein 2 orthopedists on our panel independently suggested that surgery shouldnt be done coz at this age bones become very fragile.

But such cases are rare may be to the tune of around 5-10%. What we are able to do is give patients more treatment options and hopefully give the patient more peace of mind. Today, Mrs Bhagwan Devi is doing well, and her family speaks highly of their experience with a remote second opinion: “We were lucky to have landed in right hands at the right time but most of the people are not even aware of the services like Second Opinion over the web. We would like more and more people to be aware of this option.”. Dr Soota ends the discussion by saying that we want to popularize this service only by word of mouth as we cant afford to spend a lot on our marketing and advertising and end up increasing our rates which would defeat the whole purpose of formation or RxOcean to reach the masses and be able to provide quality health care services at a very nominal price.

Dont ignore that pain – Talk to a Doctor – Seek Second Opinion

Recently a very close relative in our family passed away cause of multiple organ failure. Deceased was extremely young ( in his early 30s) which showcases the things that we ignore at times shouldn’t be ignored. Any signal that the body gives should be taken seriously and listened to. Body is like a machine with many parts operating in sync with each other. Even when one of the parts malfunction some sort of screaching sound or some sort of pain is experienced in one part or the other part.

This young man had been complaining of some minor pain just above his waist for past couple of months but no one knew what is happening inside his body and the pain was not that severe. As a result family ignored the same until when the signals became stronger and he started having fever. Even later when he fell ill – for 10 continuous days he was treated with medicines for various ailments that are seasonal like flu, viral or even dengue and malaria. Doctor in his town wasn’t able to diagnose the problem in his body. Fever was coming on and off for at-least couple of weeks.

Finally someone impressed upon the family that a second opinion is required and the patient was rushed to another specialist in Chandigarh where he was asked to get a number of tests done to diagnose the root cause of his illness. Upon looking at the reports doctor immediately asked the patient to get admitted in emergency ward of a major hospital in Chandigarh. But things had gotten out of control by the time he was admitted to critical care.

This extensive suffering could have been avoided if the local emergency department and family physicians, instead of assuming his symptoms to be typical of the viral or dengue from which he was suffering, had stopped to ask ‘what else could this be?’ He was later diagnosed to be suffering from well-described complications of kidney and liver. By the time he was admitted to the hospital his intestine had ruptured as it had lots of toxins in it and lever and kidneys had stopped functioning. Even after doing dialysis on every alternate day, doctors couldn’t revive any of his organs.

I am not saying that this is the case of a wrong diagnosis and blaming the doctor but such lives can be saved easily if we are a little bit careful with our bodies. Even OTC drug abuse ( Paracetamol ) has been known to affect liver. What does it take to talk to a doctor or take professional help. Now that things have become so advanced that you can talk to a professional doctor or even see a doctor and doctor can hear your heart beat through phone then what stops people from consulting that doctor. Moreover with every passing day technological advances in medical technology are letting doctors diagnose better and some doctors by virtue of their location are better informed about the changes in medicine then others.

RxOcean, www.rxocean.com is an initiative of doctors and other members of the community to help those patients whose lives have been impacted by missed or delayed diagnosis, to help clinicians around the world do the best job for their patients. RxOcean helps people take second opinion over the web and that too at a very nominal cost.